4-RFQt-02-CIQ Form.pdf
PDF 418 KB Posted
- Solicitation number
- 25-0239
- Issued by
- Tarrant County, Texas
About this file
This document is a Conflict of Interest Questionnaire (CIQ) from the City of Fort Worth Purchasing Division for a Request for Quote (RFQt) titled "Automated Weather Observation Station Equipment and Calibration Services" with the reference number 25-0239. The CIQ is a mandatory form pursuant to Chapter 176 of the Local Government Code, which requires any person or agent seeking to contract with a local governmental entity to disclose potential conflicts of interest. The form must be filed with the City of Fort Worth Secretary no later than seven days after beginning contract discussions or submitting a proposal, and updated questionnaires must be filed in accordance with the chapter's requirements.
The document outlines the legal obligations for vendors doing business with the local governmental entity, specifically detailing the conditions under which a conflict of interest must be disclosed. These conditions include employment or business relationships with local government officers, receiving taxable income exceeding $2,500 in a 12-month period, or receiving gifts with an aggregate value of more than $100. The form requires vendors to provide detailed information about their relationships with local government entities, including any employment connections, potential financial benefits, or gifts exchanged. Failure to comply with these disclosure requirements can result in a Class C misdemeanor, emphasizing the importance of transparency and ethical business practices in government contracting.
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Text version
CITY OF FORT WORTH - PURCHASING DIVISION
CONFLICT OF INTEREST QUESTIONNAIRE (CIQ)
RFQt Ref. #: 25-0239 Doc. Ref#: RFQt-02 Page 1 of 3 RFQt Title: Automated Weather Observation Station Equipment and Calibration Services
Pursuant to Chapter 176 of the Local Government Code, any person or agent of a person who contracts or seeks to contract for the sale or purchase of property, goods, or services with a local governmental entity (i.e. City of Fort Worth) must disclose in the Conflict of Interest Questionnaire Form “CIQ” the person’s affiliation or business relationship that might cause a conflict of interest with the local governmental entity. By law, the Questionnaire must be filed with the City of Fort Worth Secretary no later than seven days after the date the person begins contract discussions or negotiations with the City or submits an application or response to a request for proposals or bids, correspondence, or another writing related to a potential agreement with the City. Updated Questionnaires must be filed in conformance with Chapter 176.
A copy of the Questionnaire Form CIQ is enclosed with the submittal documents.
The form is also available at https://www.ethics.state.tx.us/forms/conflict/
If you have any questions about compliance, please consult your own legal counsel.
Compliance is the individual responsibility of each person or agent of a person who is subject to the filing requirement. An offense under Chapter 176 is a Class C misdemeanor.
NOTE: If you are not aware of a Conflict of Interest in any business relationship that you might have with the City, state the Proposer name in # 1, and use N/A in each of the areas on the form. However, a signature is required in the #7 box in all cases.
RFQt Ref. #: 25-0239 Doc. Ref#: RFQt-02 Page 2 of 3
RFQt Ref. #: 25-0239 Doc. Ref#: RFQt-02 Page 3 of 3
| lJ Name of vendor who hasa business relationship with local govemmantal entity: |
| w Describe each employmanl or business 19la1ionship that the vendor1namld iin Section 1 maintains with a corporation or other busiooss entity with mspect to which the local governmant officer serves as an oflicer or diHCtor or holds an ownership in1Brnst of ooo percent or moN1: |
| Slgna1ure of veooiJr ooing 6usmess wlffi tfie governmental ennty: |
| la1e: |
| Check Box1: Off |
| Text2: |
| Text3: |
| Check Box4: Off |
| Check Box5: Off |
| Check Box6: Off |
| Check Box7: Off |
| Check Box8: Off |
File details come from the government source that posted it. Updated .